Central serous chorioretinopathy

The symptoms of central serous chorioretinopathy (CSC) can vary in severity and may come on suddenly, often worsening under conditions of stress or fatigue. They include:

• Blurred vision, particularly in one eye
• Distorted vision
• A dark or grey spot in the centre of your visual field
• Difficulty distinguishing between subtle shades of grey or colour
• Objects appearing smaller than they actually are
• Colours appearing washed out or less vibrant

The exact cause of central serous chorioretinopathy (CSC) is not well understood, but the condition has been associated with a number of factors, including:

• High levels of stress, possibly due to an increased production of cortisol and other stress related hormones
• Oral and topical corticosteroid use
• ‘type A’ personalities – individuals who are prone to becoming stressed, or have a competitive nature are more susceptible
• Pregnancy, due to hormonal changes during pregnancy
• Hypertension (high blood pressure)
• Genetics – a family history of CSC may increase susceptibility
• Other associated factors, which are less common and not necessarily causal include:
• Use of stimulants, such as caffeine and alcohol
• Cushing’s syndrome, which can cause elevated levels of cortisol and stress hormones
• Autoimmune diseases, such as lupus and rheumatoid arthritis (steroid treatment may be the cause)
• Infection caused by the bacterium Helicobacter pylori
• Kidney disease, such as glomerulonephritis
• Sleep apnoea, possibly due to its effects on overall cardiovascular health and stress levels

Understanding these factors can help to manage and potentially prevent episodes of CSC. During a consultation, one of our specialist consultants can help you to consider your risks.

The key investigations for diagnosing and evaluating central serous chorioretinopathy (CSC) include:

• An eye examination – your consultant will perform a full examination of your eye and retina to detect fluid accumulation or other abnormalities
• Optical coherence tomography – this non-invasive imaging technique provides detailed cross-sectional images of the retina, enabling your consultant to visualise the fluid under the retina and the extent of retinal detachment, and evaluate the choroidal thickness
• Autofluorescence imaging – this simple imaging technique uses naturally occurring fluorescence from the retina to assess the health of the retinal pigment epithelium (RPE), a key layer of cells which is damaged or dysfunctional in this condition
• Fluorescein angiography (FA) – this involves injecting fluorescein dye into the bloodstream. Once the dye has reached the blood vessels in your retina, your consultant will take a series of photographs of the retina to help identify any leakage points and the exact location of the fluid accumulation, and the extent of damage to the RPE
• Indocyanine green angiography – this is a similar technique to FA but uses a different dye which is particularly useful for visualising the deeper layers of the choroid, the layer where most of the problem lies in CSC
• Optical coherence tomography angiography – this technique provides a more detailed analysis of your retina to detect any secondary complications, such as new vessel growth, which may have arisen in cases of chronic or persistent CSC

These investigations can help to confirm the diagnosis of CSC, determine the severity of the condition and guide the management and best treatment approach.

Many cases of central serous chorioretinopathy (CSC) resolve spontaneously within one or two months. During this period, your consultant will continue to check on the progression of the condition and assess whether further intervention is needed.

If your CSC is particularly symptomatic, severe or chronic, your consultant may recommend one of the following treatment approaches:

• Reducing or discontinuing corticosteroid therapy – this will depend on whether your consultant considers these medications to have been a contributing factor, this decision is jointly made between the patient, the ophthalmologist and the doctor who has prescribed the steroid treatment
• Photodynamic therapy – this involves using a light-sensitive drug (verteporfin) and a non-thermal laser to seal leaking blood vessels in the retina
• Focal laser therapy – this treatment can help to settle an episode of leakage from solitary leaking points if they’re not impacting the very centre of your retina
• Lifestyle changes – such as stress management techniques (e.g. meditation and counselling) and avoiding stimulants
• Anti-vascular endothelial growth factor (anti-VEGF) injections – this treatment can treat new blood vessels adding to fluid leakage, only used if this secondary complication arises
• Micropulse laser therapy – using small, short, low-energy laser pulses to target the epithelium without damaging the retina, this treatment is not usually considered as a first line option

Your consultant may recommend any combination of these approaches, depending on the severity of your condition, the underlying causes and your overall health.

Regular follow-ups with your consultant will be needed to ensure the condition is being managed properly and you are able to recover properly.